Pat Basu, MD, MBA: The Radiologist in the White House

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While radiologists have served in prominent positions in Washington, DC, in the past, none have ever served as White House fellow and special assistant to the president before the recent appointment of Pat Basu, MD, MBA, as one of 13 men and women to serve in the 2010–2011 class of fellows. An attending radiologist at Stanford University and the VA Palo Alto Health Care System in California, Basu is course director of health policy, finance, and economics and a former Rutherford fellow in the Washington ACR® office. White House fellows usually spend a paid year working with senior White House staff, Cabinet secretaries, and other top-ranking officials, and their responsibilities include chairing interagency meetings, designing and implementing federal policy, and drafting speeches for Cabinet secretaries. Radiology Business Journal spoke with Basu to find out why he would leave the faculty of one of the most prestigious teaching institutions in the country (and take a 70% to 80% pay cut) to spend a year in the White House. RBJ: Why now? What led you to Washington at this time? Basu: I am a first-generation American. My parents had come to this country well over 40 years ago; my older brother (who happens to be a radiologist), my younger sister, and I were not born yet, but they came for the American dream. I still very much believe in the American dream and in the ideals and freedoms this country offers. I look back at all of the people who have believed in me: teachers, coaches, parents, family, and friends. With my energy, background, and training in medicine and business, I feel that there is something I owe and that I have to offer. Many people told me the same thing: If you get this appointment, that would be incredible, but it is a bad time. We are in two wars, the economy is in a shambles, the health-care system is broken, the education system is broken; it’s tough, but that’s the nature of the work. If I can make a difference in the lives of people, that would be very fulfilling for me. RBJ: As course director at Stanford of health policy, finance, and economics, you have a great vantage point from which to comment on how The Patient Protection and Affordable Care Act of 2010 could affect radiology. With so many references to accountability and bundling in the legislation, what are the dangers for radiology? Basu: The biggest danger for radiology is not to be a part of the solution—not to be at the table. Radiologists are uniquely positioned to understand so many elements of the health-care system. We are in one of the few specialties that sees patients in the outpatient setting, the emergency department, and the inpatient setting. We are in one of the few specialties that sees patients for ailments from the brain to the lungs, the abdomen, and all the way down to the legs and toes. We also deal with a lot of high–capital-expenditure equipment that we have a great amount of control over; we are very uniquely positioned. My biggest fear is that radiologists and physicians at large will not participate in the process. If you don’t participate in the process, you leave yourself open to not having a voice. I’ve seen that many times, in the past, in various physician capacities, and in people who are not members of the ACR. If you are not active directly, then you should be active indirectly. That is what they need to think about: the long-term future of health care. RBJ: Are there specific opportunities for radiology to participate in meaningful reform? Basu: Specifically, it would be in contributing to how we can maximize appropriate imaging. How can we decrease inappropriate imaging? More generally, a lot of people get fixated on the details of the conversation, and the devil is in the details. What it really takes is an initial conversation. Sit down with legislators and administrators and begin a conversation. Here’s a story I share in a leadership class that I do: People on one side of the class are given a sheet of paper that says they need a bunch of oranges to make orange juice, and those on the other side are given a sheet of paper saying they need a bunch of oranges to use the peel to make lotion. They argue back and forth without realizing there is a win–win solution for both sides. If one side gets the peels and the other side gets the juice, they can both win. All too often, all of the parties in medicine—radiologists, physicians in general, administrators, and legislators—are not seeing the overall picture as a potential win–win situation; they are seeing it as a zero-sum game. More of those conversations involving radiologists, other physicians, and CMS administrators are what need to happen. Quite frankly, I think there are solutions that we haven’t even thought of yet. RBJ: What unique value will the perspective of a radiologist bring to health-care policymakers in the White House? Basu: We are some of the best-positioned physicians to see patients across horizontal integrations: We see them in every level of care, from chronic care to acute care, across subspecialties. If you make an axis vertically of all of the subspecialties, and then horizontally for the different settings in which you see patients, we are in one of the few specialties that sees virtually every single box. To the vertical and horizontal axes, add 3D: We also deal with procedures, high-tech equipment, diagnosis, and treatment. We have a very broad perspective, and that perspective is what I hope to bring. RBJ: What advice would you offer to radiology departments and private practices that are seeking to prepare for health-care reform? Basu: Take the first step: Engage in that conversation. I don’t want to tell people what to say before they have started that conversation. RBJ: Do you know what you are going to be doing in Washington? Basu: I do not. I have to interview with the different secretaries over the next month or so. My appointment doesn’t officially start until August 30. I have a general idea of the overall position, but what I will be working on is still to be determined. RBJ: How much time are you spending in the reading room these days, and how will you continue to practice your skills in Washington? Basu: Currently, I am spending more than 70% to 80% of the time in the reading room. In Washington, my primary responsibility is going to be the federal-government job. RBJ: What are the three most important things that you will pack in your suitcase? Basu: I am going to get existential. The most important thing I can bring is the versatile personal and professional background that makes me who I am. I’ve had a lot of different experiences in different jobs, and I am a very outgoing person in talking with people and hearing their ideas. That conglomeration of education and experience is number one. Number two is the high energy and positive outlook that I bring to the table. Those two won’t fit in a suitcase, but they are the main things I need to bring. Is there something that can go in a suitcase? Being in Stanford and living in California, I very rarely wear a tie at the office, but working at the White House is going to be a little different. A nice collection of new ties is probably going to be necessary.